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Measuring safety of healthcare: an exercise in futility?
  1. Khara Sauro1,
  2. William A Ghali2,
  3. Henry Thomas Stelfox3
  1. 1 Departments of Community Health Sciences, Surgery & Oncology, the O'Brien Institute for Public Health & the Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alberta, Canada
  2. 2 Departments of Community Health Sciences & Medicine, and the O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
  3. 3 Departments of Critical Care Medicine & Community Health Sciences, and the O'Brien Institute for Public Health, Universty of Calgary, Calgary, Alberta, Canada
  1. Correspondence to Dr Khara Sauro, University of Calgary, Calgary, AB T2N 1N4, Canada; kmsauro{at}

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Insanity—doing the same thing over and over again, and expecting different results.1

Anyone who has received or delivered care understands it is vulnerable to fail. After each failure, the narrative is familiar and recited often—continuous quality improvement is invoked, and performance measurement is touted as a core strategy. Yet, does any of this make a difference?

Almost 20 years ago the Institute of Medicine published ‘To Err is Human’, a widely cited report that highlighted the all-too-frequent occurrence of adverse events, negative and unintended consequences of healthcare.2 An estimated 1 in 10 hospital admissions results in an adverse event3 and 98 000 deaths occur per year as a consequence of adverse events.2 4 In addition to the human cost, adverse events burden the healthcare system—they increase hospital length of stay by an average of 10 days and cost in excess of $414 million per year.5 It is hard to know just how safe care is. Measuring safety is imperfect and there is little evidence that it makes care safer. But we have an ethical imperative to do no harm, which requires us to understand how safe care actually is. Measurement is therefore needed, because after all, we cannot fix or improve what we do not measure.

Despite several commentaries discussing the advantages of existing methods to measure adverse events, controversy about the best method remains.6–16 Many resources have been devoted to determining the most valid method for detecting adverse events, and even more resources have gone towards implementing these measurement approaches within organisations. Discouragingly, however, these approaches have done little to improve the safety of care.17 18 Unlike previous discussions, we submit that the volume and complexity of patient–healthcare system interactions necessitates the development of new, more efficient yet accurate methods for detecting adverse events …

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  • Contributors All authors contributed to the conception, design, drafting and editing of the manuscript and approved the version of the manuscript being submitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement There are no data in this work.

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